1985, 05-17 Permit App: 00005472 GarageBUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name Q-
A►4NA6;%iv
n(llast) (( {� !(first) (m
it r'
Department Use Only
F. �/ Comm
2 Project Address (not Mailing Address) or Road Name Space Zip
) 2z wq 1L\L1 <Q 99Z06
3 City/Community
State
Subdivision/Plat Name
4 Assessor Parcel No.
0 _, I 1 1 ' ( J' -j_ 'v
(Code f
Lot
3I
Block
* * * DEPARTMENT USE ONLY * * *
5 Sic
ZonefAct. #
Zone
fri*,
Project No.
5-4/67
6 Dwell #
No. of Buildings
Sq. Ft./Acre
Depth �� (
Frontage t
66
7 Set Back-Frontt
(L)S-1
(R)S-2 !Rear
2 t _—
6`I
Census Tract
I Module No.
Initials hi)J J V
16 Architect Firm Name
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
Contractor Frm Name
Street Address
Zip
deb q ? � D Cc,
at))
.7 -Po iz 4ke
State
L&J 4
Phone
(so?) ? z _ --? 3 az,
Contact Person
',/414/
License No.
Phone if different than above
( )
8 Owner/Agent (if different than #1 above)
Business Address
9 Zip
City
State
Phone
( )
12 Review Required
Plan Check (YIN)
Other (YIN)
I SEPA Exempt (Y/N)
Date
15 Type Work p}. Bldg
D Fire
❑ MH
❑ Demo
❑ New
`� Add/Alter
❑ Replace
❑ Move
❑ Other
14 Describe Work 6 el e 8
1
10 Applicant Name
Street Address
11 Zip
City
State
Phone
( )
Lender
Street Address
Zip
City
State
Phone
( )
Contact Person
Phone if different than above
( )
1
Additional Information
DEPARTMENT APPROVALS
•
❑
❑
Application Type
(Standard unless
otherwise indicated)
Fast Track
Early Start
1 nis is nota rermit
(Indicated approvals required in either "release" or "release with conditions"
to Issuance.)
space prior permit
Release
Release
w/cond 1
Hold 2
X
Environmental Health ❑ Commercial; ❑ Residential
W. 1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200
❑ Additional structure;
�_ J/'
APPLICATION # �.Sv1
Conditions/Comments:
❑
Planning/Zoning: ❑ Commercial; ❑ Cert. of Exemption; ❑ Frontage;
721 Jefferson 0 Setbacks; ❑ lot w/d; 0 lot size; 0 use/zone;
N.
n CU, variance, zone change; shoreline; 0 fence;
0 Other
Conditions/Comments'
Engineers: ❑ Commercial; 0 Residential; 0 Flood Plain;
N. 811 Jefferson 0 drainage ❑ new access/approach; 0 fence;
❑ road improvements
Conditions/Comments•
❑
Utilities:
N. 811 Jefferson
Conditions/Comments•
•
Other:
❑
Plan Exam
Fire Prev.
Conditions/Comments•
f Information 0
Project Representative Telephone
Agencies Performing Special Inspection:
1
2
3
1 Indicate above or attach conditions relative to final as built approval
2 Indicate above or attach reasons for hold
� � G
06